Atheroma

After age 30 the coronary arteries become slowly obstructed
by sludge consisting of cholesterol and smaller blood
particles called platelets. The sludge forms a hardness, or
plaque, which doctors call atheroma. These plaques bulge
into the interior of the arteries, obstructing the free
flow of blood.
The word atheroma is derived from the Greek ‘‘athere’’
meaning porridge or gruel. When a plaque of atheroma is
cut open, one can see a gelatinous, porridge-like material
which contains cholesterol. Fortunately, this porridge-like
fatty material does not touch the blood that flows through
the artery, because nature covers the fatty material with a
protective hard layer of cells called fibrous tissue. A plaque
of atheroma therefore consists of a central fatty core,
covered by a fibrous cap (Fig. 1).
Fibrous tissue is formed from special cells that are
produced everywhere in the body when a repair job is
needed; for example, a few days after a large cut or surgical
wound is stitched, fibrous tissue cells move in to form a
bridge, which transforms over the next few weeks into a
scar. Some scars are smooth and some are bumpy and
rough. Plaques of atheroma are also sometimes smooth or
bumpy and rough. These tough scars in the inner wall of
the arteries are perhaps nature’s way of patching and
healing. Because the vessel wall affected by atheroma gets
hardened and the medical word for hardness is sclerosis,
the term used for this disease is atherosclerosis.
Plaques of atheroma are most common in the
abdominal aorta where it divides to form the vessels to
the pelvis and lower limbs, in the coronary arteries, in
the carotid arteries to the neck and brain, and in the vessels
of the lower limbs.
When atherosclerosis in the coronary arteries causes
symptoms, doctors use the term ‘‘atherosclerotic heart
disease,’’ coronary artery disease, or coronary heart disease
(CHD). Many doctors use the term ischemic heart disease
because ischemia means a lack of blood and/or oxygen
caused by poor delivery of blood from arteries to the tissue.
Angina, heart attacks, heart failure, and arrhythmias are
the main manifestations of CHD.

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